Systemic Factors influencing the Continuity of Home-Based Palliative Care Network following the Transfer of Sub-District Health Promoting Hospitals to the Provincial Administrative Organization: A Case Study of Phitsanulok Province

Abstract

The transfer of sub-district health promoting hospitals (SHPHs) to provincial administrative organizations (PAOs) is a major decentralization policy in Thailand that may affect the continuity of home- and community-based palliative care services. This qualitative study aimed to examine the continuity of service delivery systems and factors influencing palliative home care following the transfer of SHPHs in Phitsanulok province. The study applied a framework based on four key pillars of the service system: health workforce, health information systems, medical supplies and equipment, and community participation.  The study was conducted within secondary- and tertiary-care service networks in Phitsanulok. Participants included 20 informants selected purposively among healthcare providers, family caregivers, and stakeholders involved in community palliative care. Data were collected through in-depth interviews and meeting observations. Content analysis was employed, and data credibility was ensured through triangulation.  The findings revealed that continuity of home-based palliative care services was maintained despite changes in administrative governance. Patients and families generally did not perceive differences in service providers after the transfer. Continuity of care was evidenced in four major dimensions. 1) Workforce: home visits and care coordination continued, although nursing workload remained a significant challenge. 2) Health information systems: effective referral processes and inter-facility data linkage were essential for seamless continuity of care. 3) Medical supplies and equipment: access to morphine and high-cost medical equipment remained limited in some areas. 4) Community participation: village health volunteers played a crucial role in screening, follow-up, and coordinating community-based care.  In conclusion, sustaining continuity of palliative care services following the transfer of SHPHs requires strengthening workforce management, integrated health information systems, medical resource support, and community participation mechanisms. These factors are essential for developing a seamless and sustainable local health service system.